Cellulitis Health Article

Diagnosis

Cellulitis may be diagnosed and treated by a family doctor, an infectious disease specialist, a doctor who specializes in skin diseases (dermatologist), or in the case of orbital cellulitis, an eye doctor (ophthalmologist). The diagnosis of cellulitis is based mainly on the patient's symptoms. The patient's recent medical history is also used in the diagnosis.

Laboratory tests may be done to determine which kind of bacteria is causing the infection but these tests are not always successful. If the skin injury is visible, a sterile cotton swab is used to pick up a sample from the wound. If there is no obvious skin injury, a needle may be used to inject a small amount of sterile salt solution into the infected skin, and then the solution is withdrawn. The salt solution should pick up some of the bacteria causing the infection. A blood sample may be taken from the patient's arm to see if bacteria have entered the bloodstream. Also, a blood test may be done to count the number of white blood cells in the blood. High numbers of white blood cells suggest that the body is trying to fight a bacterial infection.

For orbital cellulitis, the doctor may often perform a special x-ray scan called computed tomography scan (CT). This scan enables the doctor to see the patient's head in cross-section to determine exactly where the infection is and see if any damage has occurred. A CT scan takes about 20 minutes.

Treatment

Antibiotic treatment is the only way to battle this potentially life-threatening infection. Mild to moderate cellulitis can be treated with the following antibiotics taken every four to eight hours by mouth:

• penicillins (Bicillin, Wycillin, Pen Vee, V-Cillin)
• erythromycin (E-Mycin, Ery-Tab)
• cephalexin (Biocef, Keflex)
• cloxacillin (Tegopen)

Other medications may be recommended, such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) to relieve pain, and aspirin to decrease fever.

A normally healthy person is usually not hospitalized for mild or moderate cellulitis. General treatment measures include elevation of the infected area, rest, and application of warm, moist compresses to the infected area. The doctor will want to see the patient again to make sure that the antibiotic treatment is effective in stopping the infection.

Persons at high risk for severe cellulitis will probably be hospitalized for treatment and monitoring. Antibiotics may be given intravenously to patients with severe cellulitis. Complications such as deep infection, or bone or joint infections, might require surgical drainage and a longer course of antibiotic treatment. Extensive tissue destruction may require plastic surgery to repair. In cases of orbital cellulitis caused by a sinus infection, surgery may be required to drain the sinuses.

Prognosis

Over 90% of all cellulitis cases are cured after seven to 10 days of antibiotic treatment. Persons with serious disease and/or those who are taking immunosuppressive drugs may experience a more severe form of cellulitis which can be life threatening. Serious complications include blood poisoning (bacteria growing in the blood stream), meningitis (brain and spinal cord infection), tissue death (necrosis), and/or lymphangitis (infection of the lymph vessels). Severe cellulitis caused by Streptococcus pyogenes can lead to destructive and life-threatening necrotizing fasciitis.

Prevention

Cellulitis may be prevented by wearing appropriate protective equipment during work and sports to avoid skin injury, cleaning cuts and skin injuries with antiseptic soap, keeping wounds clean and protected, watching wounds for signs of infection, taking the entire prescribed dose of antibiotic, and maintaining good general health. Persons with diabetes should try to maintain good blood sugar control.

BOOKS

Dermatology. 3rd ed. Ed. Peter J. Lynch. Baltimore: Williams and Wilkins, 1994.

Westfall, Christopher T., John W. Shore, and Ann Sullivan Baker. "Orbital Infections." In Infectious Diseases. 2nd ed. Philadelphia: W. B. Saunders Co., 1998.

PERIODICALS

Lewis, Ronald T. "Soft Tissue Infections." World Journal of Surgery 22, no. 2 (Feb. 1998): 146-51.

OTHER

Mayo Clinic Online. 5 Mar. 1998 <http://www.mayohealth.org>.

Belinda Rowland, PhD

KEY TERMS

Inflammation—A local, protective response to tissue injury. It is characterized by redness, warmth, swelling, and pain.

Necrotizing fasciitis—A destructive infection which follows severe cellulitis and involves the deep skin and underlying tissues.

Sinuses—Air cavities found in the bones of the head. The sinuses which are connected to the nose are prone to infection.